In efforts led by the Department of Justice (DOJ), $3.1 billion was paid out to the federal government and private persons in 2020 as a result of healthcare fraud investigations, according to an annual...
Akron General Health System (AGHS), a hospital system in Ohio owned by the Cleveland Clinic Foundation, reached a civil settlement and agreed to pay $21 million for allegedly committing healthcare...
Large stimulus packages passed in response to the COVID-19 pandemic will create an opportunity for more False Claims Act (FCA) enforcement, especially in the healthcare sector, lawyers from Hogan...
The Centers for Medicare & Medicaid Services (CMS) and its contractors did not use Comprehensive Error Rate Testing (CERT) data to identify healthcare fraud or waste, according to a new Office of...
2020 will not only go down in the history books as the year COVID-19 hit, but also as a historic year for healthcare fraud takedowns.
The Department of Justice recently reported that it has charged...
After years of debate, HHS agencies have made changes to two major healthcare fraud, waste, and abuse laws that providers have said get in the way of value-based care progress.
Late last week, CMS and...
Aggressive corrective actions aimed at reducing Medicare fee-for-service (FFS) improper payments have resulted in less healthcare fraud, waste, and abuse, as well as $15 billion in savings, according...
In the wake of the first confirmed cases of COVID-19 in the US, policymakers quickly relaxed long-standing healthcare regulations, including telemedicine reimbursement and healthcare fraud prevention...
The Office of the Inspector General (OIG) at HHS expects to return over $1.5 billion to the federal government from healthcare fraud schemes investigated during the first half of the fiscal year,...
Texas-based Baylor Scott & White Health has again beat a False Claims Act lawsuit alleging that it inflated medical codes in order to maximize Medicare reimbursement.
On May 28, the US Court of...
Leading hospital groups are urging the Department of Justice to ease penalties from the Anti-Kickback Statute and other federal healthcare fraud laws during the COVID-19 public health emergency.
For...
The Department of Justice recovered over $3 billion from False Claims cases in the 2019 fiscal year, with $2.6 billion coming form healthcare fraud schemes.
In a recent announcement, the Justice...
The Department of Justice (DoJ) announced on Tuesday that it has filed a complaint against Community Health Network following a whistleblower lawsuit accusing the Indianapolis-based health system...
Tying Anti-Kickback and Stark Law reform to the level of financial risk providers assume creates more complexity and burden and could impede the transition to value-based care for physicians, advocacy...
HHS’ Office of Inspector General (OIG) is taking steps toward “much needed reform” of Medicare fraud laws, but more can be done to remove the value-based care barriers presented by...
CMS recently announced that the Medicare fee-for-service (FFS) improper rate declined further from fiscal years (FY) 2017 to 2019, reaching the lowest level since FY 2010.
The FY 2019 Medicare FFS...
Medicare fraud not only wastes billions of taxpayer dollars annually, but it also carries a significant human cost, according to a study from researchers at Johns Hopkins Bloomberg School of Public...
CMS and the Department of Veterans Affairs (VA) recently announced a new data sharing initiative in which the departments will share provider enrollment data to prevent healthcare fraud, waste, and...
In light of new value-based care models and creative partnerships between providers, CMS is ditching its pay-and-chase approach to reducing Medicare fraud, waste, and abuse and implementing a new...
HHS recently made moves to update the Stark Law and Anti-Kickback Statute, two healthcare fraud rules created decades ago that have prevented physicians, hospitals, and other healthcare providers from...
